Showing papers in "Neurosurgery in 1980"
TL;DR: The results indicate that blood localized in the subarachnoid space in sufficient amount at specific sites is the only important etiological factor in vasospasm and it should be possible to identify patients in jeopardy from vasospasms and institute early preventive measures.
Abstract: In 47 cases of verified ruptured saccular aneurysm, we investigated the relationship of the amount and distribution of subarachnoid blood detected by computerized tomography to the later development of cerebral vasospasm. When the subarachnoid blood was not detected or was distributed diffusely, severe vasospasm was almost never encounters (1 of 18 cases). In the presence of subarachnoid blood clots larger than 5 X 3 mm (measured on the reproduced images) or layers of blood 1 mm or more thick in fissures and vertical cisterns, severe spasm followed almost invariably (23 of 24 cases). There was an almost exact correspondence between the site of the major subarachnoid blood clots and the location of severe vasospasm. Every patient with severe vasospasm manifested delayed symptoms and signs. Excellent correlation existed between the particular artery in vasospasm and the delayed clinical syndrome. Severe vasospasm involved the anterior cerebral artery in 20 cases and the middle cerebral artery in only 14. As the grading system used is partly subjective, the findings should be regarded as preliminary. The results, if confirmed, indicate that blood localized in the subarachnoid space in sufficient amount at specific sites is the only important etiological factor in vasospasm. It should be possible to identify patients in jeopardy from vasospasm and institute early preventive measures. (Neurosurgery, 6: 1--9, 1980)
2,840 citations
TL;DR: Small sets of clinical features were identified that, when combined, yield high quality predictions of long term outcome that allows bedside predictions in individual patients and provides a tool for comparing the severity of injury between series of patients.
Abstract: In this study small sets of clinical features were identified that, when combined, yield high quality predictions of long term outcome. The study is based on a series of 305 consecutive head-injured Dutch patients, all of whom had been in coma for at least 6 hours. The overall social outcome was assessed after 6 months using the Glasgow outcome scale. Predictions of outcome were made by assigning probabilities to each possible outcome category. The prognostically most promising features recorded during the early post-traumatic course were identified, and powerful combinations of prognostic features were selected on admission and 1, 3, 7, 14, and 28 days after the start of coma by an appropriate statistical method. At each time point, optimal prediction required sets of only three to five features, typically including age in decades, depth and duration of coma as assessed by the Glasgow coma scale, pupil reactivity to light, and spontaneous and reflex eye movements. The method described allows bedside predictions in individual patients and provides a tool for comparing the severity of injury between series of patients.
254 citations
TL;DR: The purpose of this presentation is to provide basic biomechanical information concerning the spine, its components, and the spinal cord and it is shown that this information is helpful in understanding the fundamental functions of the spinal column.
Abstract: The purpose of this presentation is to provide basic biomechanical information concerning the spine, its components, and the spinal cord. It is shown that this information is helpful in understanding the fundamental functions of the spinal column. The experimentally determined physical properties of the vertebra, various spinal ligaments, the disc, and the spinal cord under many different loading conditions are described. The role of the special characteristics of the spine ligaments in allowing physiological motions of the spine, preventing excessive motions between vertebrae, and protecting the spinal cord during trauma are discussed. Movements of the spinal cord within the spinal canal and associated changes of its section during physiological movements of the spine are also described. The kinematics of the various regions of the spine are discussed and their clinical significance is presented. The problems of spinal trauma and is associated spinal instability are analyzed. Guidelines are recommended to assess spinal stability. The proper application of such guidelines will provide the basis for sound clinical judgments.
247 citations
TL;DR: In January 1978 the Central Nervous System Injury Investigative Group at the University of California, San Diego, in concert with the San Diego Academy of Neurological Surgeons, began collecting data on the epidemiology, pattern, and severity of central nervous system injury in San Diego County.
Abstract: In January 1978 the Central Nervous System Injury Investigative Group at the University of California, San Diego, in concert with the San Diego Academy of Neurological Surgeons, began collecting data on the epidemiology, pattern, and severity of central nervous system injury in San Diego County. As
192 citations
TL;DR: The accumulated retrospective experience with glioblastoma multiforme was reviewed and survival curves were constructed for 1561 selected cases that did not include limited surgery and/or astrocytoma Grade III.
Abstract: The accumulated retrospective experience with glioblastoma multiforme was reviewed. Data were extracted from 17 reports in the literature, comprising 2532 patients. Survival curves were constructed for 1561 selected cases that did not include limited surgery and/or astrocytoma Grade III. The median survival after operation for the 1561 patients was 6 months, and only 7.5% lived 2 years. The survival curve is exponential in shape; calculation of its rate constant as well as extrapolation on a least squares regression line for the semilogarithmic plot of the data both predict 3- and 5-year survival rates of 1.7 and 0%, respectively. Curves were also plotted for patients who were treated by operation alone (6 study groups, 349 cases), operation plus radiation (11 groups, 568 cases), and operation plus radiation plus chemotherapy (5 groups, 146 cases); the median survival times for the three groups were 4, 9.25, and 10 months, respectively. It was concluded that (a) all curves converge at 18 to 24 months, irrespective of treatment; (b) radiotherapy is the decisive treatment during the first 18 months; (c) survival can be predicted by adopting an exponential model; and (d) prospective studies are required to detect the marginal benefits of current therapies.
183 citations
182 citations
TL;DR: The relationship of the anterior inferior cerebellar artery (AICA) to the facial and vestibulocochlear nerves was studied using 3x to 20x magnification in 50 cerebellopontine angles (CPAs) from 25 adult cadavers.
Abstract: The relationship of the anterior inferior cerebellar artery (AICA) to the facial (7th) and vestibulocochlear (8th) nerves was studied using 3x to 20x magnification in 50 cerebellopontine angles (CPAs) from 25 adult cadavers. The AICA originated from the basilar artery as a single (72% of the CPAs), duplicate (26%), or triplicate (2%) artery. Each of the 50 CPAs had one or more arterial trunks that coursed in close proximity to the 7th and 8th cranial nerves and thus were said to be nerve-related. The nerve-related arterial trunks were divided into three segments based on their relationship to the nerves and meatus: the premeatal, meatal, and postmeatal segments. The meatal segment projected to the meatus or into the canal in 64% of the CPAs. In relation to the nerves, the premeatal segment was most commonly anteroinferior, the meatal segment was inferior, and the postmeatal segment was posteroinferior. The nerve-related branches of the AICA gave rise to internal auditory arteries in 100% of the 50 CPAs, recurrent perforating arteries in 82%, and the subarcuate artery in 72%. The internal auditory and recurrent perforating arteries arose most commonly from the premeatal segment, and the subarcuate artery arose most commonly from the postmeatal segment. There were one to four internal auditory arteries per CPA, zero to three recurrent perforating arteries, and zero or one subarcuate artery. The effects of occlusion of the nerve-related arteries and their involvement in conditions treated by neurosurgeons are reviewed.
180 citations
TL;DR: Reversible, transient osmotic barrier disruption was achieved 15 times in five patients without additional toxicity, providing further evidence that the barrier is at least partially intact in human tumors because in one patient a metastsis was seen only after barrier disruption.
Abstract: The blood-brain barrier seems to be an important factor in drug access to malignant brain tumors. Successful experimental reversible disruption of the blood-brain barrier in animals provided the basis for a clinical evaluation of osmotic disruption in five patients with primary and metastatic malignant brain tumors. Good to excellent blood-brain barrier disruption was achieved in four patients with a single nontransient complication, a superficial wound infection at the burr hole site in the first patient. Reversible, transient osmotic barrier disruption was achieved 15 times in five patients without additional toxicity. Computed tomography and radionuclide brain imaging were shown to be useful noninvasive monitors of the adequacy and extent of barrier disruption. These studies also provide further evidence that the barrier is at least partially intact in human tumors because in one patient a metastsis was seen only after barrier disruption.
164 citations
TL;DR: Seven of 8 delayed traumatic intracerebral hematomas were associated with clotting abnormalities suggesting disseminated intravascular clotting and fibrinolysis (DICF), which suggests an increased risk of bleeding in association with the insertion of ventricular catheters in patients with DICF.
Abstract: Twelve delayed or recurrent intracranial hematomas were seen in 340 patients with head injuries. Eleven of these hematomas were associated with clotting abnormalities suggesting disseminated intravascular clotting and fibrinolysis (DICF). Seven of 8 delayed traumatic intracerebral hematomas were associated with clotting abnormalities. Two of these were at ventriculostomy sites, which suggests an increased risk of bleeding in association with the insertion of ventricular catheters in patients with DICF. There were 2 delayed epidural hematomas, 1 under a fracture and the other on the side opposite a craniotomy that had been made to treat an intracerebral hematoma, and there were 2 postoperative epidural hematomas. No postoperative hematomas occurred in the absence of DICF. DICF is a major factor in the development of delayed and recurrent intracranial hematomas in patients with head injuries.
161 citations
TL;DR: The superior cerebellar artery (SCA) was present in each of the 50 hemispheres and had points of contact with 32 oculomotor, 46 trochlear, and 26 trigeminal nerves.
Abstract: Fifty cerebellar hemispheres from 25 adult cadavers were examined. The superior cerebellar artery (SCA) was present in each of the 50 hemispheres. Forty-three SCAs arose as a single trunk, and 7 arose as duplicate trunks. One solitary trunk and the rostral trunk of one duplicate vessel arose from the posterior cerebral artery. The remainder arose from the basilar artery. The SCA was divided into four segments: the anterior pontomesencephalic segment lay below the oculomotor nerve; the lateral pontomesencephalic segment course; below the trochlear and above the trigeminal nerve; the cerebellomesencephalic segment coursed in the groove between the cerebellum and the upper brain stem; and the cortical segment was distributed to the cerebellar surface. The SCAs arising as a single trunk bifurcated into a rostral and a caudal trunk, corresponding to the runks formed by a duplicate origin. The rostral trunk supplied the medial and the caudal trunk supplied the lateral parts of the cerebellar cortex. The SCA gave off perforating, precerebellar, and cortical arteries. The perforating arteries penetrated the interpeduncular fossa, the cerebral peduncles, the junctions of the superior and middle cerebellar peduncles, and the colliculi. The precerebellar branches arose within the cerebellomesencephalic groove and supplied the adjoining parts of the cerebellum and brain stem. The cortical branches were divided into vermian, hemispheric, and marginal arteries. The 50 SACs had points of contact with 32 oculomotor, 46 trochlear, and 26 trigeminal nerves. (Neurosurgery, 6: 10--28, 1980)
147 citations
TL;DR: C cerebral metabolic depression and vasoconstriction from sodium thiopental reached a plateau when sufficient barbiturate was administered to produce EEG burst suppression of between 30 and 60 seconds, and at this level there was no important cardiovascular depression.
Abstract: High dose barbiturate therapy is being used with increasing frequency in the management of a widening spectrum of neurological disorders. Accurate regulation of the barbiturate dose is essential to maximize cerebral vasoconstriction and reduce brain metabolism while avoiding the cardiovascular depressant side effects of the drug. The purpose of this study was to determine whether the electroencephalogram (EEG) could be used to regulate administration of the agent. In nine mongrel dogs cerebral blood flow (CBF) was determined using the radioactive microsphere technique. After the determination of control CBF, a slow infusion of sodium thiopental was begun. CBF determinations were repeated when the periods of burst suppression in the EEG over several minutes averaged 30, 60, 120, and 240 seconds. CBF and oxygen metabolism showed a nearly identical pattern of a precipituos drop from control levels reaching a plateau at burst suppression between 30 and 60 seconds. Changes in cerebrovascular resistance were of a similar but opposite nature. Significant increases in heart rate occurred with burst suppression of 30 seconds, whereas the arterial pressure and cardiac index decreased with burst suppression between 30 and 60 seconds. In this study cerebral metabolic depression and vasoconstriction from sodium thiopental reached a plateau when sufficient barbiturate was administered to produce EEG burst suppression of between 30 and 60 seconds. At this level there was no important cardiovascular depression. Administration of additional barbiturates significantly decreased systemic arterial pressure and cardiac output, but produced no further decrement in the cerebral metabolic rate of oxygen or the CBF. There was no predictable relationship between cerebral metabolism or cardiovascular function and blood levels of sodium thiopental.
TL;DR: Thirty patients who met the rigid criteria for a prospective randomized study of cerebrospinal fluid (CSF) shunt infections underwent therapy with the three currently advocated treatment modalities to determine the efficacy of each form of therapy.
Abstract: Thirty patients who met the rigid criteria for a prospective randomized study of cerebrospinal fluid (CSF) shunt infections underwent therapy with the three currently advocated treatment modalities to determine the efficacy of each form of therapy. Ten patients (Group A) underwent shunt removal and,
TL;DR: Six cases of traumatic dissection of the extracranial carotid artery are reported, and four-vessel angiography was diagnostic in all six patients and was useful during follow-up in the four in whom it was done.
Abstract: Six cases of traumatic dissection of the extracranial carotid artery that were all treated conservatively are reported. The initial trauma was believed to be an intimal tear caused by severe stretching of the artery over the process of a cervical vertebra due to sudden hyperextension and lateral fle
TL;DR: Computed tomography is an invaluable diagnostic tool and it seems that, since it has become widely used in the evaluation of patients with headaches or dementia, colloid cysts are being recognized with increasing frequency.
Abstract: In this paper 33 cases of colloid cyst of the 3rd ventricle are presented. The initial symptoms as well as the clinical syndromes are quite variable, but usually consist of a combination of signs of increased intracranial pressure and an organic dementia, progressive or paroxysmal. Computed tomography is an invaluable diagnostic tool and it seems that, since it has become widely used in the evaluation of patients with headaches or dementia, colloid cysts are being recognized with increasing frequency. Different modalities of treatment are discussed. The transcortical and transcallosal approaches are both effective techniques, but the latter is probably preferable in cases with mild ventricular dilatation.
TL;DR: It may be possible in the future to identify those patients at risk of developing cerebral vasospasm by assessing the location and amount of subarachnoid blood by computerized tomography, which would aid the development of measures to prevent intracranial arterial spasm.
Abstract: Published accounts of attempts at prevention or treatment of intracranial arterial spasm have been reviewed. These data are summarized in a table according to the agent tested, the dosage used, the route of administration, and the animal species used. Precautions are given concerning the organization and assessment of such studies. The best current management of patients with cerebral vasospasm involves promoting cerebral perfusion and avoiding detrimental factors. It may be possible in the future to identify those patients at risk of developing cerebral vasospasm, perhaps by assessing the location and amount of subarachnoid blood by computerized tomography. This would aid the development of measures to prevent intracranial arterial spasm, which seems to be a more promising approach to the problem than is treatment.
TL;DR: This paper describes the development of a nearly artifact-free stereotactic frame designed for CT imaging that is spatially integrates with the CT images of the patient and with the scanner gantry to provide rapid coordinate determinations.
Abstract: Computed tomography (CT) has become the first modality to provide the patient's self-brain map for stereotactic neurosurgery. This paper describes our development of a nearly artifact-free stereotactic frame designed for CT imaging. The surgical procedure is performed within the CT scanner itself. The scanner's computer, via a new software program, spatially integrates the new stereotactic frame with the CT images of the patient and with the scanner gantry to provide rapid coordinate determinations, calculate potential probe trajectories, obtain target accuracy within 1 mm, and observe for any procedural complications. Our initial clinical experience with this system is described.
TL;DR: The sciatic nerve was injected with regional anesthesia to examine possible toxic effects on peripheral nerve tissue of local anesthetic agents and found it to have no neurotoxic properties.
Abstract: Although regional anesthesia is generally considered to have no neurotoxic properties, significant nerve injury has been reported after its use. The present study was undertaken to examine possible toxic effects on peripheral nerve tissue of local anesthetic agents. We injected the sciatic nerve of
TL;DR: Rigorous adherence to a protocol incorporating these findings justifies the acceptance of gaseous EO as a safe, relatively rapid, and inexpensive sterilant of bone and soft tissues.
Abstract: The use of allogeneic human bone, dura, and fascia has achieved an enduring and accelerating role in the augmentation of spinal fusions and the repair of skeletal and dural defects. Primary sterilization of these nonviable cadaveric tissues magnifies the potential sources and ensures the microbiological sterility of the implant. Subsequent lyophilization facilitates preservation and distribution and reduces the immunogenicity of the graft. The evaluation of gaseous ethylene oxide (EO) as a sterilant was suggested by the delerious effects of alternative methods. Through a series of experiments, the following properties of EO sterilization were studied: (a) surface and interstitial sterilization; (b) the diffusion of EO into tissue, the formation of the reaction products ethylene chlorohydrin (EC) and ethylene glycol (EG), and the desorption of all three from tissues; (c) lyophilization and aeration in the removal of residues; and (d) minimization of residues through pretreatment. Gaseous EO is a very effective surface sterilant of wet bone, dura, and fascia and does not grossly alter these tissues. Its partial penetration through compact bone renders it less reliable for an interstitial antimicrobial effect, unless access to the interior is provided by serial openings. The toxicity of EO, EC, and EG mandates the desorption through lyophilization of these compounds (EC and EG are formed during sterilization with EO). Before sterilization, bone must be rid of marrow by vigorous irrigation with deionized water. The resultant reduction of the number of cells and of the available chloride decreases antigenicity and the formation of EC. Freeze-drying for more than 72 hours, in some cases augmented by prolonged aeration at room temperature, reduces EO, EC, and EG to acceptable levels. The accurate assay of residues in tissue requires acetone extraction for gas chromatography on rehydrated tissues because extraction of dry tissues gives falsely low results. Rigorous adherence to a protocol incorporating these findings justifies the acceptance of gaseous EO as a safe, relatively rapid, and inexpensive sterilant of bone and soft tissues.
TL;DR: A baboon model of reversible cerebral ischemia, achieved by external compression with an implantable, inflatable balloon cuff in awake, unanesthetized baboons, demonstrated a "recruitment response" of increasingly persistent deficit with repeated occlusion.
Abstract: The authors describe their experience with a baboon model of reversible cerebral ischemia. Middle cerebral artery occlusion was achieved by external compression with an implantable, inflatable balloon cuff in awake, unanesthetized baboons. Selective cerebral angiography confirmed consistent, reliable occlusion. Computed tomography demonstrated early density changes after ischemia, which were reversible with reperfusion. Neurological evaluation demonstrated a "recruitment response" of increasingly persistent deficit with repeated occlusion. Permanent deficits were noted after extensive angiography during periods of occlusion. This was accompanied by the dropout of small vessels in the middle cerebral artery distribution. The results of pathological examinations were consistent with the clinical examinations. No gross or microscopic changes were noted after repeated occlusions that caused deficits like those of transient ischemic attacks. Consistent infarctions were noted in animals with permanent deficits after permanent occlusion or after repeated occlusion and extensive angiography.
TL;DR: Both simple decompression and anterior transposition result in improvement in 82% of the cases; however, a higher percentage of full recovery was seen in the cases treated bysimple decompression, which is explained by the facts that the nerve is not handled and its vital blood supply is left intact.
Abstract: The authors report 235 cases of ulnar neuropathy at the elbow. The treatment was simple decompression in 115 cases and anterior transposition in 120 cases. Men were affected 3 times as often as women. The average age of presentation was 54.5 years. The nondominant arm was involved more frequently. The etiology of ulnar neuropathy was diverse, but one-third of the cases fell into the idiopathic category. Numbness and paresthesia were the most common complaints. Examination revealed hypalgesia of the little finger and the medial half of the ring finger, with weakness and wasting of the intrinsic muscles of the hand. Electromyography and nerve conduction studies are important for early diagnosis. Young men with a symptom duration of 1 year or less have a better chance of improvement after the operation. Both simple decompression and anterior transposition result in improvement in 82% of the cases; however, a higher percentage of full recovery was seen in the cases treated by simple decompression. This is explained by the facts that the nerve is not handled and its vital blood supply is left intact.
TL;DR: It is suggested that CT performed within 4 days after SAH may give important information for predicting cerebral vasospasm, and no relationship was found between HD and the occurrence of cerebral Vasospasm in cases in which CT was performed after the 5th day of disease.
Abstract: The relationship between high density (HD) on computed tomographic (CT) scans (which indicates a collection of blood in the subarachnoid space) and cerebral vasospasm was studied in 177 patients with ruptured aneurysm. The development of cerebral vasospasm was confirmed at the high rate of 84.6% in 26 cases where HD was demonstrated on the CT scan within 4 days after subarachnoid hemorrhage (SAH). In 8 cases where HD was not found on the CT scan obtained within 4 days after SAH, no cerebral vasospasm was seen. However, no relationship was found between HD and the occurrence of cerebral vasospasm in cases in which CT was performed after the 5th day of disease. It is suggested that CT performed within 4 days after SAH may give important information for predicting cerebral vasospasm.
TL;DR: The natural history of patients who survive a cervical carotid dissection is usually one of stability or improvement and a trial of medical therapy and repeat arteriography are indicated before the consideration of surgical therapy.
Abstract: Thirteen cases of cervical carotid dissecting aneurysm have been seen at the University of Florida during the past 3 years. In our experience, two groups of patients with this disease can be distinguished clearly by either clinical or angiographic criteria. One group of cervical carotid dissecting aneurysms is characterized by spontaneous onset, unilaterality, and the absence of pseudoaneurysm formation. These lesions have a strong tendency to resolve with appropriate medical therapy. The other group is characterized by an association with obvious predisposing factors, such as fibromuscular dysplasia, angiography, or trauma. These lesions are often associated with pseudoaneurysms and rarely resolve spontaneously. These two groups of lesions probably represent a spectrum of the same basic disease process. The natural history of patients who survive a cervical carotid dissection is usually one of stability or improvement. A trial of medical therapy (to prevent embolic symptoms) and repeat arteriography are indicated before the consideration of surgical therapy.
TL;DR: Brain methotexate levels were maximized by giving this chemotherapeutic drug by the intracarotid rather than the intravenous route after osmotic BBB disruption, and tests of MTX levels in cerebrospinal fluid were found to be a very unreliable and inconsistent monitor of brainMTX levels after oSmoticBBB disruption.
Abstract: Infusion of 25% mannitol into the internal carotid artery of the dog results in a reversible disruption of the blood-brain barrier (BBB). This osmotic BBB disruption enhances the penetratin of systemically administered methotrexate (MTX) into the ipsilateral cerebral hemisphere. Brain methotexate levels were maximized by giving this chemotherapeutic drug by the intracarotid rather than the intravenous route after osmotic BBB disruption. Assays of MTX levels in cerebrospinal fluid were found to be a very unreliable and inconsistent monitor of brain MTX levels after osmotic BBB disruption.
TL;DR: A preliminary evaluation of the sequential Bayes method for predicting the outcome of patients with severe head injury shows the feasibility of using early data to predict outcome accurately and of being able to rank input variables in order of their prognostc significance.
Abstract: Determining the prognostic significance of clinical factors for patients with severe head injury can lead to an improved understanding of the pathophysiology of head injury and to improvement in therapy. A technique known as the sequential Bayes method has been used previously for the purpose of pro
TL;DR: The administration of low dose heparin based on an epidemiological analysis of the risks involved would seem to be an effective method of prophylaxis in patients who underwent major cranial or spinal operations.
Abstract: In 100 patients who underwent major cranial or spinal operations, the incidence of lower extremity deep vein thrombosis was 29%. Of importance was the presence of known risk factors, particularly leg weakness and a long operation. The subject of deep vein thrombosis and its complications in neurosurgical disorders is reviewed and its prophylaxis is discussed. The administration of low dose heparin based on an epidemiological analysis of the risks involved would seem to be an effective method of prophylaxis.
TL;DR: The data suggest that mechanical forces may play a role in the etiology of some cases of craniosynostosis and the fact that head shape spontaneously remolded in one of the five cases suggests further that surgical correction may not be required in all cases in which constraint is the suspected etiological of the deformation.
Abstract: Intrauterine constraint is responsible for a number of structural defects of the craniofacial and peripheral skeleton including plagiocephaly, micrognathia, congenital hip dislocation, and talipes equinovarus. This report describes five infants with serious craniofacial alterations, all attributable to intrauterine constraint. All five children had clinical and laboratory evidence strongly suggestive of craniosynostosis. In three of the five, sutural fusion was documented either at operation or at necropsy. In the other two the clinical course indicated that true synostosis was not present. In all cases the sutural involvement corresponded to the dimension in which head growth had been restricted. This determaination was based upon an assessment of the other craniofacial alterations that were present. The etiology of the intrauterine constrain was different in each case. Factors involved included breech presentation, primagravidity, uterine malformations, amniotic bands, and defects in fetal neuromuscular development, all of which are known to produce fetal deformations. As further evidence of severe constraint, fetal activity was greatly reduced during four of the five pregnancies. There was no history of craniosynostosis in other family members. We propose that in utero compression may lead to a spectrum of craniofacial defects that includes craniosynostosis when the constraint is particularly prolonged. The data suggest that mechanical forces may play a role in the etiology of some cases of craniosynostosis. The fact that head shape spontaneously remolded in one of the five cases suggests further that surgical correction may not be required in all cases in which constraint is the suspected etiology of the deformation. (Neurosurgery, 6: 39-44, 1980).
TL;DR: One hundred thirty consecutive cases of percutaneous lumboperitoneal shunting are reviewed and the efficacy of this procedure in the management of cerebrospinal fluid fistulas and bulging craniotomies is documented.
Abstract: One hundred thirty consecutive cases of percutaneous lumboperitoneal shunting are reviewed. The efficacy of this procedure in the management of cerebrospinal fluid fistulas and bulging craniotomies is documented. The place of lumboperitoneal shunts in the management of communicating hydrocephalus, w